- Humana (Indianapolis, IN)
- …caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health ... services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …or relocation to Louisiana is preferred for all positions. **POSITION PURPOSE** The Behavioral Health Utilization Reviewer is responsible for conducting ... clinical reviews of behavioral health service requests, claims, and appeals...to providers and members in a clear, timely, and professional manner. **How You Contribute to the Company's Mission… more
- Centene Corporation (Springfield, IL)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and...and Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …insurance ABA coverage policies. + Experience with interprofessional collaboration in behavioral health settings. _The Physical Demands described here are ... all positions. **POSITION PURPOSE** . The Board Certified Behavior Analyst (BCBA), Utilization Reviewer role is responsible for evaluating the medical necessity and… more
- Omaha Children's Hospital (Omaha, NE)
- …us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are ... opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case Management… more
- Omaha Children's Hospital (Omaha, NE)
- …us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are ... opportunity employer including veterans and people with disabilities. **A Brief Overview** Utilization Management (UM) is a specialty area of Nursing Case Management… more
- UnityPoint Health (Cedar Rapids, IA)
- …+ Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in coordinating ... the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of...State of Iowa Licensed RN + Two years of behavioral health work experience. + Professional… more
- Humana (Juneau, AK)
- …Qualifications** + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health ; MED-Deeming ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management +...standards knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional . +… more
- Molina Healthcare (NM)
- …Association** Active, unrestricted Utilization Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential.… more
- Centene Corporation (Tallahassee, FL)
- …experience in applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / ... of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder...and Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN… more
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